ANESTHESIA TECHNIQUES | General Anesthesia, TIVA, MAC, and Sedation, Co-existing Disease Flashcards
The leading cause of death and severe nervous system injury during MAC is:
A. Hypoxia
B. Arrhythmia
C. Hypoxemia
D. Circulatory collapse
A. Hypoxia
Barash | 9th edit
TRUE or FALSE
At the present time, no single drug can provide all the
components of monitored anesthesia care (i.e., analgesia,
anxiolysis, and hypnosis) with an acceptable margin of safety or ease of titratability.
TRUE
TRUE or FALSE
Monitored anesthesia care DOES NOT describe the continuum of depth of sedation
TRUE
This depth of sedation maintains normal response to verbal stimuli and the airway, spontaneous ventilation, and cardiovascular function are unaffected.
A. Minimal
B. Moderate
C. Deep
D. General Anesthesia
A. Minimal
The depth of sedation often referred to as “conscious sedation”. It maintains purposeful response to verbal and light touch stimuli
A. Minimal
B. Moderate
C. Deep
D. General Anesthesia
B. Moderate
This depth of sedation maintains purposeful response to REPEATED or painful stimuli but may lose responsiveness to verbal or light touch stimuli:
A. Minimal
B. Moderate
C. Deep
D. General Anesthesia
C. Deep
- cardiovascular function is usually
maintained even if AIRWAY may need assistance.
Based on MODIFIED RAMSAY sedation scale, The following assessment corresponds to which of the following score?
The following are observed:
Patient appears asleep, purposeful responses to verbal commands but at louder than usual conversational level, requiring light glabellar tap, or both. What is the RAMSAY score?
A. 8
B. 6
C. 4
D. 3
C. 4
The patient has no response to voice, but any movement to physical stimulation is elicited corresponds to what RASS score:
A. -2
B. -3
C. -4
C. -4
-5 No response to voice or physical stimulation
-4 No response to voice, but any movement to physical stimulation
-3 Any movement (but no eye
contact) to voice
-2 awakens in less than 10 secs
with eye contact to voice
-1 Not fully alert, but has sustained
(more than 10 s) awakening, with
eye contact, to voice
0 Alert and Calm
+1 to +4 = * Scores indicate restlessness to combativeness and do not reflect anxiolysis
Based on the ASA closed claims study, what is the the leading cause of death and severe nervous system injury during MAC?
A. Hypoxia
B. Arryhthmia
C. Seizure
D. Hypoxemia
A. Hypoxia
From the ASA closed claims study of Bhananker et al.,5 we learned that the leading cause of death and severe nervous system injury during MAC is hypoxia due to suppression of spontaneous respiration by sedative– hypnotic drugs
CONTEXT SENSITIVE HALF-TIME of Fentanyl
In the case of fentanyl, drug that is irreversibly eliminated from the plasma by hepatic clearance is immediately replaced by drug returning from the peripheral compartments.
Thus, although fentanyl has a shorter elimination half-life than that of sufentanil (462 vs. 577 minutes), its context-sensitive half-time is much greater than that of sufentanil after an infusion of longer than 2 hours. The storage, and later release, of fentanyl from peripheral binding sites delay the decline in plasma concentration that
would otherwise occur.
What is the clinical reason between thiopental and propofol in terms of their context-sensitive H/T?
This difference between thiopental and propofol is attributable to:
(1) the high metabolic clearance of propofol compared with thiopental, and
(2) the relatively slow rate at which propofol returns to the plasma from peripheral
compartments.
A patient undergoing lumbar spine fusion surgery is monitored by measuring lower extremity somatosensory evoked potentials (SSEPs). Which of the following is MOST likely to cause a 50% INCREASE from baseline in the SSEP latency?
A. Anterior spinal artery ischemia
B. Compression of the anterior column of the spinal cord
C. Changing from an inhaled anesthetic to a total intravenous anesthetic
D. Compression of the dorsal column of the spinal cord
A. Anterior spinal artery ischemia
- Anterior spinal cord compression may not have any effect on SSEPs.
- Changing to a total intravenous anesthetic would most likely decrease SSEP latency.
- Lower extremity SSEPs are not transmitted by the dorsal column of the spinal cord.
Cyclosporine toxicity is MOST commonly seen in which of the following solid organs?
A. Lung
B. Kidney
C. Pancreas
D. Heart
B. Kidney
- Although cyclosporine has been reported to be associated with the development of bronchospasm, cough, and dyspnea, pulmonary sequelae are not the most common complications.
- Toxicity of the pancreas does not occur with cyclosporine administration.
*Although cyclosporine has been reported to be associated with myocardial infarction, dysrhythmias,
and heart failure, cardiac complications are not the most common manifestation of cyclosporine
toxicity.
In adults under general anesthesia, which one of the
following is the best-preserved temperature regulatory
mechanism?
A. Vasoconstriction
B. Shivering
C. Sweating
D. Behavioral thermoregulation
E. Nonshivering thermogenesis
C. Sweating
The thermoregulatory threshold, below which humans
actively regulate body temperature, is decreased during
general anesthesia and is less effective under anesthesia.
Compared to the other homeothermic mechanisms, sweating is the best-preserved mechanism under general anesthesia.
The threshold for sweating is only slightly increased
and the effectiveness of sweating is well preserved under
general anesthesia. Under general anesthesia the thresholds
for shivering and vasoconstriction are markedly reduced
and less effective than normal when activated.
- Nonshivering thermogenesis does not occur in anesthetized adults and is inhibited in infants.
Which mechanism for heat loss is most significant in
anesthetized surgical patients?
A. Convection
B. Radiation
C. Conduction
D. Evaporation
B. Radiation
Which of the following agent or drugs is HIGHLY considered to be safe from MALIGNANT HYPERTHERMIA?
A. Succinylcholine
B. Droperidol
C. Nitrous Oxide
D. Halothane
B. Droperidol
Which of the following is the MOST deleterious effect of neonatal hypothermia?
A) Acute hypoglycemia
B) Atrial fibrillation
C) Decreased plasma metanephrines
D) Metabolic acidosis
E) PEA
D) Metabolic acidosis
Metabolic acidosis, which results from ketone production in brown fat metabolism (nonshivering thermogenesis), is maladaptive in the neonate and is the most critical consequence of a decrease in temperature.
Neonates and infants are at a higher risk of hypothermia, especially in the operating room, as they lack the normal compensatory mechanism of shivering. Neonates have a larger body surface area-to-weight ratio and less subcutaneous fat, both of which help to promote heat loss.
In a response to heat loss, neonates begin a process called nonshivering thermogenesis. Nonshivering thermogenesis is the metabolism of brown fat. Brown fat makes up 4-10% of fat stores in the neonate and is high in mitochondria. Brown fat can be found in a neonate from 26 weeks and up and disappears around 3-6 months after birth.
When there is at least a 2° C (3.6° F) gradient between the skin and core temperature, the hypothalamus stimulates a release of norepinephrine into the blood stream.
Which of the following mechanisms is most frequently responsible for hypoxia in the recovery room?
A. Ventilation/perfusion mismatch
B. Hypoventilation
C. Hypoxic gas mixture
D. Intracardiac shunt
A. Ventilation/perfusion mismatch
Hypoparathyroidism secondary to the inadvertent surgical resection of the parathyroid glands during total thyroidectomy typically results in airway symptoms of hypocalcemia how many hours postoperatively?
A. 1 to 2 hours
B. 3 to 12 hours
C. 12 to 24 hours
D. 24 to 72 hours
D. 24 to 72 hours
Damage to which nerve may lead to wrist drop?
A. Radial
B. Axillary
C. Median
D. Ulnar
A. Radial
A 25-year-old woman with a body mass index (BMI) 42 kg/m2 is to be anesthetized for laparoscopic bariatric surgery. Her American Society of Anesthesiologists (ASA)
designation should be:
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
C. ASA III
Which of the following oral antidiabetic drugs is unique in that it does NOT produce hypoglycemia when administered to a fasting patient?
A. Glyburide (Micronase)
B. Glipizide (Glucotrol)
C. Tolbutamide (Orinase)
D. Metformin (Glucophage)
D. Metformin (Glucophage)
Scopolamine should not be given as a premedication in patients with which of the following neurologic diseases?
A. Parkinson disease
B. Alzheimer disease
C. Multiple sclerosis
D. Narcolepsy
B. Alzheimer disease
Which of the following is LEAST likely to develop intraoperative awareness?
A. C- section under GA
B. Emergency damage control laparotomy
C. history of opioid use
D. patient with red hair
D. patient with red hair
MAC is primarily an indicator of ___
A. solubility
B. potency
C. uptake
D. partial pressure at 1 ATM
B. potency
MH is believed to involve a generalized disorder of membrane permeability to
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
C. Calcium
Select the TRUE statement regarding the use of depolarizing
and nondepolarizing muscle relaxants in a patient who sustained 3rd degree burn 12 days prior, compared with normal patients.
A. Sensitivity to both depolarizing and nondepolarizing muscle relaxants is increased
B. Sensitivity to both depolarizing and nondepolarizing muscle relaxants is decreased
C. Sensitivity to depolarizing muscle relaxants is increased while sensitivity to nondepolarizing muscle relaxants is decreased
D. Sensitivity to depolarizing muscle relaxants is decreased while sensitivity to nondepolarizing muscle relaxants is increased
C. Sensitivity to depolarizing muscle relaxants is increased while sensitivity to nondepolarizing muscle relaxants is decreased
A patient undergoes parotid gland removal under general anesthesia. Each of the following assesses facial nerve function EXCEPT
A. Clenching teeth
B. Closing eyes
C. Pursing lips
D. Eyebrow lift
A. Clenching teeth
Which of the following steps would produce the greatest increase in O2 delivery to the myocardium?
A. Administration of 100% O2 with a close-fitting mask
B. Administration of 35% O2 with a Venturi mask
C. Administer 1 ampule of HCO3
D. Transfuse with 2 units of packed red blood cells (RBCs)
D. Transfuse with 2 units of packed red blood cells (RBCs)
Allergic reactions occurring during the immediate perioperative period are MOST commonly attributable to administration of:
A. Muscle relaxants
B. Local anesthetics
C. Antibiotics
D. Opioids
A. Muscle relaxants
Caution is advised when using succinylcholine in patients with Huntington chorea because:
A. They are at increased risk for MH
B. Potassium release may be excessive
C. They may have a decreased concentration of
pseudocholinesterase
D. There may be adverse interactions between succinylcholine and phenothiazine
C. They may have a decreased concentration of
pseudocholinesterase
This MELD score is considered LOW RISK for post-operative morbidity and mortality:
A. 11
B. 15
C. 20
D. 18
A. 11
Which of the following would NOT result in an increase in intraocular pressure?
A. Increase in PaCO2 from 35 to 40 mm Hg
B. 100 mg intramuscular (IM) succinylcholine
C. Acute rise in venous pressure from coughing
D. 100 mg IV succinylcholine in a patient in whom eye muscles
have been detached from the globe
A. Increase in PaCO2 from 35 to 40 mm Hg
Which of the following is an important consideration concerning the pulmonary toxicity of bleomycin?
A. N2 O should not be used
B. Preoperative pulmonary function tests should be obtained
C. The patient should be ventilated at a slow rate and inspiratory-toexpiratory (I:E) ratio of 1:3
D. FIO2 should be less than 0.3
D. FIO2 should be less than 0.3
The incidence of each of the following is increased in patients with Down syndrome (trisomy 21) EXCEPT
A. MH
B. Congenital heart disease
C. Smaller trachea
D. Occipito-atlantoaxial instability
A. MH
MH and neuroleptic malignant syndrome share each of the following characteristics EXCEPT
A. Generalized muscular rigidity
B. Hyperthermia
C. Effectively treated with dantrolene
D. Flaccid paralysis after administration of vecuronium
D. Flaccid paralysis after administration of vecuronium
What of the following statements about vasopressin is true?
A. It has a potent vasopressor effect at high doses in normal subjects
B. Plasma levels are inappropriately high in patients immediately after cardiopulmonary bypass
C. Plasma levels are inappropriately low in the setting of septic shock
D. It causes pulmonary vasoconstriction secondary to inhibition of
endothelial nitric oxide release
C. Plasma levels are inappropriately low in the setting of septic shock
A term infant with good muscle tone and strong cry has an 83% saturation on room air 5 minutes after delivery. The MOST appropriate action at this point would be:
A. Bag and mask ventilation with 100% oxygen
B. Intubate and ventilate with 100% oxygen
C. Spontaneous breathing with 100% oxygen
D. Observe
D. Observe
Patients who undergo extracorporeal shock wave lithotripsy are at increased risk for:
A. Venous air embolism
B. Pneumothorax
C. Hypotension with regional anesthesia at the end of the procedure
D. Postdural puncture headache with spinal anesthesia
C. Hypotension with regional anesthesia at the end of the procedure
The most common reason for admitting outpatients to the hospital following general anesthesia is:
A. Nausea and vomiting
B. Inability to void
C. Inability to ambulate
D. Surgical pain
A. Nausea and vomiting
A 40-year-old man is undergoing a left inguinal hernia repair under general anesthesia in San Diego, California. N2 O is administered at 3 L/min, O2 at 1 L/min, and isoflurane at 0.85%. What MAC is this patient receiving?
A. 0.8
B. 1.25
C. 1.50
D. 1.75
C. 1.50
Which of the following TCI model uses plasma effect?
A. Marsh
B. Schneider
A. Marsh
Modified child-pugh score utilizes the following parameters EXCEPT:
A. Ascites
B. Encephalopathy
C. INR
D. Albumin
D. Albumin
TRUE or FALSE
When administering IV drugs to a patient with liver pathology:
Drugs with LOW HEPATIC EXTRACTION RATIO have restrictive clearance?
TRUE
TRUE or FALSE
HIGH EXTRACTION RATIO have shorter elimination half-lives?
TRUE!
- There is an inverse relationship between extraction ratio and elimination half-life
- Drugs with HIGH EXTRACTION RATIO are also HIGHLY LIPOPHILIC.
TRUE or FALSE
A patient with MELD score of equal to or more than 20 should have a LIVER TRANSPLANT before proceeding to any HIGH RISK elective surgery.
TRUE!
Remember, MELD score of 11 is good!
MELD score of 20 or more is BAD!!
Which of the following is MUST be given to reverse urokinase in a hemorrhaging patient requiring surgery?
A. Cryoprecipitate
B. FFP
C. Tranexamic Acid
A. Cryoprecipitate
Bleeding from Urokinase = Cryoprecipitate
Which of the following is LEAST important in the anesthetic management of a patient with Multiple Sclerosis?
A. Autonomic dysfunction is common in MS
B. MS patient are resistant to muscle relaxant
C. Myopathy is common
D. Succinylcholine produces exaggerated K release
E. Tonic clonic seizure is common
B. MS patient are resistant to muscle relaxant
- MS are sensitive to muscle relaxant
TRUE or FALSE
It is imperative to withhold broad spectrum anti-epileptic drugs preoperatively among those patients with epilepsy?
FALSE
May give AED (anti-epileptic drugs) with caution.
Which of the following medications should be avoided perioperatively in pt with Parkinsons Disease?
A. Apomorphine
B. Omeprazole
C. Desflurane
D. Droperidol
E. Ketamine
D. Droperidol
Which of the following laboratory tests would be the MOST useful in evaluating whether s patient is euthyroid?
A. Total plasma thyroxine (T4 )
B. Total plasma triiodothyronine (T3 )
C. Thyroid-stimulating hormone (TSH)
D. Resin triiodothyronine uptake
C. Thyroid-stimulating hormone (TSH)
Is the only ventilatory parameter that has consistently been shown to improve respiratory function in obese patients:
A. PEEP
B. TV
C. Pressure Support
D. Minute Ventilation
A. PEEP
It is the weight associated with the lowest mortality rate for a given height and gender:
A. IBW
B. TBW
C. Actual body weight
D. PBW
A. IBW
How much reduction of FRC occur in obese patients during anesthesia?
A. 50%
B. 40%
C. 30%
A. 50%
Is the most sensitive indicator of the effect of obesity on pulmonary function:
A. ERV
B. TLC
C. Closing capacity
D. IRV
A. ERV
The gold standard technique for diagnosing OSA is?
A. Overnight polysomnography
B. Arterial blood gas study
C. Nitrogen wash
A. Overnight polysomnography
Which clotting factor is correlated with increased cardiovascular mortality:
A. VIII
B. IX
C. X
D. II
A. VIII
TRUE or FALSE
The renal clearance is decreased or in obesity?
FALSE
Renal clearance of drugs is INCREASED in obesity because of increased renal blood flow and glomerular filtration rate
Drugs that should be based on TBW:
Propofol (maintenance)
Succinylcholine (pseudocholinesterase activity increases)
Dexmedetomidine
Neostigmine
Sugammadex
Local anesthetic dosing should be based on?
A. IBW
B. Actual body weight
C. Total body weight
A. IBW
